Quality of Life of HIV Infected Children Attending the Antiretroviral Clinic, University College Hospital, Ibadan.

BACKGROUND: HIV infection is still prevalent in Sub-Saharan Africa. The presence of a chronic illness in childhood, such as HIV infection, can affect the health-related quality of life (QoL) negatively. OBJECTIVE: The study compared the QoL of HIV-infected and uninfected children in order to assess the impact of HIV infection and antiretroviral therapy on the QoLof children. METHODS: It was a comparative cross-sectional study in which 150 primary caregivers of both HIV infected and HIV non-infected children were recruited. Data was collected on sociodemographic characteristics, negative life events and QoL domain scores on health perception, physical resilience, functional status, physical functioning, psychological functioning, social/role functioning and HIV-related symptoms from the primary caregiver and analysed. RESULTS: Mean age of HIV infected and non-infected children was 3.0 ± 0.9 years and 2.9±1.0 years respectively. HIV infected children had a greater proportion of their grandparents (15% versus 1%, p<0.05) being their primary caregiver. HIV infected children were associated with significantly worse mean QoLscore compared with HIVnon-infected children (p<0.05). Advanced HIV infection was associated with low QoL. Use of Antiretroviral Therapy (ART) among the HIV infected children was associated with a higher QoL in the general health rating, physical resilience, functional score, symptom, social and role functioning domains (p<0.05) except for physical functioning and psychological functioning. CONCLUSION: HIV infection in children is associated with poor QoL. Advance HIV disease was associated with poor QoL and antiretroviral therapy was associated with improved QoL in HIV infected children.

Hand Hygiene Practice Among Health Care Workers in a Tertiary Hospital in Sub-Saharan Africa (Handy Study).

BACKGROUND: Hand hygiene (HH) practices are emphasized as the single most important way of reducing HealthCare-Associated Infection (HCAIs). This study was done to assess the compliance with hand hygiene and knowledge about standard HH practices by health care workers as well as to assess the availability of HH materials in the largest tertiary Hospital in Nigeria. METHODS: A cross-sectional, observational study involving consecutive observations during routine patient care in various units of the University College Hospital (UCH), Ibadan; using a checklist and compliance forms adapted from the WHO guidelines was done. HH knowledge scores were categorized as < 4 = poor, 4-6=fair and >7 = good. RESULTS: A total of 559 HH opportunities were identified and overall compliance was 30.4% (170/ 559). Compliance differed by units: Neonatology SCBU (68.2%), Intensive Care Unit (41.8%), Obstetrics & Gynaecology (39.4%), Adult emergency (26.7%), Children emergency (24.6%), Medicine (22.4%), Surgery (14.9%) and Paediatrics (12.8%). Nurses were more likely to practice hand hygiene (33.2%) compared to doctors (29.0%) [c2 = 33.270, CI= 95%, P<0.001]. Female HCWs had higher hand hygiene compliance (30.6% vs. 25.4%) [c2= 2.129, CI= 95%, P= 0.345]. Soap and water were employed more (95.5%) compared to alcohol-based hand rub (4.5%). Only 12.1% had good HH knowledge scores (>7). CONCLUSION: Poor HH compliance is observed at the facility and is attributable to inadequate education, poor knowledge of standard HH practices and unavailability of HH materials in most of the units. A multidimensional approach is advocated to tackle these issues.

Comparative Weight Gain with Ready-to-Use Therapeutic Food in Stunted HIV-Infected and -Uninfected Children in a Nigerian Hospital

Objective. To bridge the management gap between nutritional rehabilitation for severe acute malnutrition (SAM) and chronic malnutrition; this study investigated to what extent ready-to-use therapeutic food (RUTF) promotes growth in children with long-term nutrition deficit with superimposed SAM. Methods. A total of 225 (164 HIV-negative and 61 HIV-positive) chronically malnourished children (aged 6 - 60 months) with superimposed SAM were enrolled. Children were provided 92 g packets of an RUTF; Plumpy'Nut; based on an estimated requirement of 200 kcal/kg body weight (BW)/day. Children were fed Plumpy'Nut over a 2-week period; and weight was assessed weekly. Weight gain was compared for HIV-positive children and HIV-negative children.Results. On day 15; the HIV-positive group had a median weight gain of 645 g compared with 670 g in the HIV-negative group (difference 25 g; p=0.784). Similarly; rate of weight gain per kilogram BW per day was comparable for both groups of children (13.2 g/kg BW per day for HIV-negative children v. 11.9 g/kg BW per day for HIV-positive children; p=0.353). On day 15; the proportions of HIV-positive and HIV-negative children who had sustained weight gain were not significantly different. Conclusion. Chronically malnourished children with superimposed SAM benefit from the use of RUTF as much as children without chronic nutritional deprivation; regardless of HIV status

Health status of children in institutionalised homes in South West Nigeria.

AIMS AND OBJECTIVES: To determine the nutritional and immunisation status as well as morbidity pattern of children in institutionalised care in south-western Nigeria. SUBJECTS AND METHODS: The study was cross sectional and involved children under the age of fifteen years in seven institutions in Oyo and Ogun states, south western Nigeria. Children admitted into these homes were either orphans or those separated from their parents through child abandonment, illness and juvenile delinquency. A history of current and recent illnesses in the preceding one month as well as immunisation was obtained for each child. Physical examination including growth assessment was then performed after which blood specimens were collected for haematocrit estimation, haemoglobin electrophoresis and examination for malaria parasites. RESULTS: A total of 161 children were studied comprising 74 (46.0%) males and 87 (54.0%) females. Their ages ranged from 1.12 to 168 months with a mean (standard deviation) of 94.5 (47.0) months. Only 24.5 % of the children were reported to have completed the immunisation schedule. Fifty five (34.2%) of the 161 children were reported to have been ill in the preceding period of one month, the leading symptoms being fever (14.9%), cough (10.3%) and diarrhoea (3.9%). Forty six (28.6%) of the children were stunted, 34 (21.1%) underweight and 106 (65.8%) anaemic. CONCLUSION: The health status of children in institutionalised care is poor and needs better supervision and support to facilitate growth and wellbeing.

Kidney disease in hospitalised HIV positive children in Ibadan, south west Nigeria.

BACKGROUND: There is a paucity of data on the clinicopathologic pattern of kidney disease in human immunodeficiency virus (HIV) seropositive children from sub-Saharan Africa and non from south west Nigeria. OBJECTIVE: To determine the clinical pattern and outcome of kidney disease among HIV positive children hospitalised at a tertiary hospital South West Nigeria METHODOLOGY: A retrospective study of all HIV positive children who were hospitalised and managed for kidney diseases over a period of 78 months at the University College Hospital Ibadan, South West Nigeria. Patients were followed up over the duration of hospital admission. RESULTS: Ten children (six males and four females) aged 4-15 (10.4 +/- 3.2) years were identified. Four presented in acute kidney injury, (AKI) three with nephrotic syndrome (NS) and two in chronic kidney failure (CKF). One patient had left renal artery stenosis. Renal biopsy performed in three children showed focal segmental glomerulosclerosis in two patients and membranous nephropathy in the third. Management included antiretroviral therapy, angiotensin converting enzyme inhibitors and acute haemodialysis. Mortality was 40%. CONCLUSION: AKI, NS and CKF were the predominant clinical patterns of kidney disease in hospitalised HIV positive children and the mortality is high.

Re-emergence of diphtheria and pertussis: implications for Nigeria.

In the prevaccine era pertussis and diphtheria were responsible for significant morbidity and mortality in children. In the United States of America more than 125,000 cases of diphtheria with 10,000 deaths were reported annually in the 1920s. In the same period about 1.7 million cases of pertussis with 73,000 deaths were also reported. Vaccination against these two diseases has caused remarkable reduction in the morbidity and mortality from these diseases both in developed and developing countries. The initial vaccines were the combined diphtheria toxoid and whole cell pertussis vaccine. The recent reported increases in the incidence of these two diseases in countries, which maintain high childhood vaccination coverage is a source of concern not only to these countries but also for developing countries with weak immunization programmes. Nigeria for example reported 11,281 cases of pertussis, the second highest number of cases worldwide in 2009. Waning immunity in adult and adolescent populations has been reported and epidemiologically, more cases are being reported in adults and adolescents. Also a high proportion of pertussis cases are being reported in infants and most of these infant cases are linked to adult/adolescent sources. Recent approaches to control of these diseases include booster doses of combined diphtheria, tetanus and acellular pertussis vaccine while the cocooning strategy (which is immunizing every person who is likely to have contact with a given infant such as mother, father, grandparents and health care workers) is being used in a number of countries. For developing countries including Nigeria where the capacity for making the diagnosis of both diseases is limited, strengthening of routine immunization as well as diagnostic capacity is imperative. Research to determine current levels of immunity in children, adolescents and adults is required. This will enable the determination of the need for booster doses and the age at which such boosters should be administered. Improved surveillance will be needed to delineate current epidemiological profiles of both diseases.

Knowledge and utilization of malaria control measures by pregnant and newly delivered mothers in Ibadan, Nigeria.

BACKGROUND: The World Health Organisation (WHO) guidelines for the control of malaria during pregnancy include prompt and effective case management of malaria combined with prevention of infection by insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp). Despite this the uptake is poor. OBJECTIVE: To describe the malaria prevention measures utilized by these women in this environment. METHODS: Information was obtained from consented pregnant and newly delivered women on their socio-demographic characteristics, knowledge and use of malaria chemoprophylaxis RESULTS: One Thousand three hundred thirty (1330) pregnant and newly delivered women in 132 facilities within the Ibadan metropolis were surveyed. The mean age of the respondents was 29. 67 years (±5.21). The modes of prevention most commonly reported as being effective were the use of insecticide spray, window nets and ITN. Only 28.2% were using ITNs in the index pregnancy, and 67.2% of the women had had a drug administered for prophylactic purposes in the index pregnancy. CONCLUSION: This study demonstrates awareness but poor use of control measures. Additionally, there is poor use of the recommended agent for IPT. The factors militating against the use of these preventive measures need to be urgently explored and addressed.

Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria.

The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH), Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these, 51614 (99.5%) accepted HIV test and 49134 (95.2%) returned for their results. Out of the tested patients, 2152 (4.2%) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361 (16.7%) with 87 (18.6%) testing positive. There were a total of 942 deliveries out of which 39.2% of the mothers and 95.2% of the babies respectively received ARV prophylaxis. In all, 85.8% (788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing, 68.3% reported for the test and 17 (8.7%) tested positive. There has been progress in the programme, reflected in the increase in the number of new clients accessing the PMTCT service. However, partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention.

Children not receiving adequate immunization in Ibadan, Nigeria: what reasons and beliefs do their mothers have?

BACKGROUND: Immunization coverage in most areas in Nigeria has remained low with continued high morbidity and mortality from vaccine preventable diseases. OBJECTIVES: To identify the reasons and beliefs about immunization among mothers whose children have not received adequate immunization or not at all. SUBJECTS AND METHODS: The study was a descriptive cross sectional survey that involved mothers trading in a large market in Ibadan who had children between the ages of 12 and 23 months. Data were collected by means of a semi-structured questionnaire. Mothers who did not immunize or failed to completely immunize their children were selected for analysis. RESULTS: A total of 248 mothers were interviewed, their mean age was 27.3 5.5 years (range 16 42 yrs). The commonest reasons for incomplete immunization included: non availability of vaccines (26.2%), not being aware of need for additional doses (16.5%) and inconvenient time/venue (13.7%). Logistic regression analysis showed that Mothers with no formal education were about six times more likely than those with secondary education and higher to give reasons related to lack of motivation (95% CI OR = 1.88 17.93). Analysis of the mothers' beliefs on immunization were as follows; 186 (75.0%) believed it was beneficial, 161 (64.9%) believed that immunization will save the life of the child and 129 (52.0%) believed that taking the child to the clinic for immunization wasted a lot oftime. CONCLUSION: Most mothers in this study agreed that immunization is beneficial. It is therefore recommended that routine immunization be strengthened, vaccines made readily available and mothers educated on the immunization schedule.

Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria

The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH); Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these; 51614 (99.5) accepted HIV test and 49134 (95.2) returned for their results. Out of the tested patients; 2152 (4.2) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361(16.7) with 87 (18.6) testing positive. There were a total of 942 deliveries out of which 39.2of the mothers and 95.2of the babies respectively received ARV prophylaxis. In all; 85.8(788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing; 68.3reported for the test and 17(8.7) tested positive. There has been progress in the programme; reflected in the increase in the number of new clients accessing the PMTCT service. However; partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention

Immunization status and its determinants among children of female traders in Ibadan, South-Western Nigeria.

Traders form a large percentage of the female work force in Nigeria and may spend long hours at work, thereby putting their children at risk of inadequate immunization. The study assessed primary immunization completion rate and the determinants of immunization status among the children of female market traders in Ibadan, South-Western Nigeria. A cross-sectional community-based survey was carried out in Bodija market among female traders who had children aged 12 to 23 months. The subjects were selected by systematic random sampling and data collected with an interviewer administered semistructured questionnaire. Logistic regression was used to estimate the predictors of incomplete immunization for the socio-demographic variables. A total of418 women were interviewed. Ninety two percent worked > or = 6 days a week and 78.5% had their children with them in the market all the time. Full immunization by both card and history was recorded in only 40.7% while 8.4% children had never been immunized. The highest vaccine coverage was seen with BCG (91.4%) while Hepatitis B (1%) had the lowest coverage. DPT1 to DPT3 vaccine drop out rate was 32.1%. All the immunizations were received in health facilities. The immunization coverage rate among children of female traders was low. Routine immunization sites should be made available in the markets.

Convergent validity of pain measuring tools among Nigerian children.

This prospective study was carried out at the Children Outpatient Clinic of the University College Hospital (UCH), Ibadan, Nigeria. The study aims to determine the convergent validity of the Oucher, Observer Pain Scale, Visual Analogue Scale (VAS) and the Numeric Rating Scale (NRS) among Nigerian children. Children aged between 6 months and 12 years who required venepuncture or phlebotomy for various investigative procedures were recruited. Demographic data and pain assessment scores were documented on a data collection form. Pain was assessed by a trained research assistant at baseline, during the procedure and immediately after the procedure using the 4 pain scales. The mean age (+/- SD) of the children was 5.5 +/- 4.3 years, boys accounted for 93 (52%) and girls 86 (48%). Pain score ranged from 0 (no pain) to 10 (worst pain) during the procedure; 72% (125) of the children had a pain score of at least 4. The median pain score during the procedure were 4 (Observer Pain Scale), 5 (Oucher) and 4 (VAS and NRS).The average measure intra-class correlation coefficient (ICC) showed that the Oucher, the VAS and the NRS pain scales are reliable pain measuring tools with an ICC of 0.63-0.69 at baseline and 0.72 - 0.73 during the procedure. The VAS, NRS and Oucher pain scales are valid pain tools that can be used to assess pain in Nigerian children.

Factors influencing time to diagnosis of childhood cancer in Ibadan, Nigeria.

BACKGROUND: Early diagnosis of cancer allows an opportunity for timely treatment while disease burden is in its earliest stages. Unfortunately, late presentation and delayed diagnosis of childhood cancers remains a problem in developing countries. OBJECTIVES: To describe the pre-diagnostic symptomatic intervals and the factors influencing these time intervals in childhood cancer at the University College Hospital, Ibadan, Nigeria. METHODS: Information was obtained from the case notes of children seen between March 2006 and August 2008. Information included socio-demographic variables, stage of the cancer, duration of illness at diagnosis and other health seeking activities. RESULTS: Sixty-four children (40 males, 24 females) were studied. Median overall lag time was 13.1 weeks; median parent delay was 2 weeks and median health system delay was 8.8 weeks. Median lag times were shortest in acute leukaemia (8.1 weeks) and Wilms. tumour (8.7 weeks) and longest in Hodgkin lymphoma (101.7 weeks). CONCLUSION: Lag times were longer than those in developed countries. Factors contributing to delayed diagnosis included delayed referral by doctors, seeking health care from alternate sources and financial constraints. Education of parents and physicians on early presentation and early referral for early diagnosis is recommended.

Situation analysis of the existing infant feeding pattern at the commencement of the prevention of mother to child transmission (PMTCT) of HIV programme in Ibadan.

OBJECTIVES: To evaluate breastfeeding and weaning practices associated socio-demographic factors and knowledge about mother-to-child transmission of HIV among mothers in Ibadan. METHODS: A cross sectional survey was conducted among 513 mothers of children aged 6- 24 months, attending infant welfare clinics. Data collection was by a structured questionnaire, which was supplemented by focus group discussions to further explore some of the issues covered in the survey. RESULTS: Breast-feeding rate was 99.4%, the duration of which ranged from 1-22 months with a median of 14 months among those who had stopped breastfeeding. Only 145 (28.3%) mothers breastfed their babies exclusively for six months and 259(50.8%) initiated breastfeeding within one hour of birth; both were associated with at least secondary level of education. The main obstacle to exclusive breastfeeding was the belief that water is required to quench thirst in babies. Expression of breast milk was not favoured by majority of the mothers (68%) most of whom felt that the milk would get contaminated. Wet nursing was rarely practiced (0.4%). Most of the mothers, 436 (85%) were aware that HIV could be transmitted through breast milk but the attitude towards a mother who did not breast feed was negative in 96.8% ofrespondents. CONCLUSIONS: Adherence to recommended infant feeding options for HIV-exposed infants are likely to be faced with challenges in a culture where breastfeeding is the norm and exclusive breastfeeding rate is low. There is need for counseling and health education on prevention of mother-to-child transmission of HIV.

Heart failure complicating tetralogy of Fallot.

BACKGROUND: Heart failure is considered to be an unusual complication of uncorrected tetralogy of Fallot. PATIENTS AND METHOD: Three adolescents with tetralogy of Fallot, presenting in congestive cardiac failure are presented. Two died. Myocardial infarction was found in the only patient that underwent autopsy, and is thought to be an important aetiological factor in the development of the heart failure in the patients. CONCLUSION: The cases presented illustrate the fact that heart failure complicating tetralogy of Fallot may not be as uncommon as was previously thought to be the case, especially in older children. There is a need for early diagnosis and expeditious institution of appropriate management before such complications occur.